Allen K S, Jorkasky D K, Arger P H, Velchik M G, Grumbach K, Coleman B G, Mintz M C, Betsch S E, Perloff L J
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
Radiology. 1988 Nov;169(2):371-6. doi: 10.1148/radiology.169.2.3051114.
Fifty-six consecutively transplanted renal allografts were prospectively evaluated with serial Doppler sonographic examinations. Thirty-eight episodes of transplant rejection in 32 patients (63% proved pathologically) and 24 episodes of acute tubular necrosis (ATN) in 24 patients were encountered. The Doppler spectral waveform was characterized by means of the pulsatility index (PI), systolic/diastolic ratio (SDR), diastolic/systolic ratio (SDR), diastolic/systolic ratio (DSR), and resistive index (RI). Accuracy was optimized with use of top normal values as follows: PI = 1.8, SDR = 4.0, DSR = 0.25, RI = 0.75. There were no significant differences in the indices for those patients undergoing rejection versus those with ATN. The sensitivity for predicting transplant rejection was adversely affected by the history of either ATN or a previous rejection episode in the same allograft. Comparison with concurrent radionuclide examinations revealed similar sensitivities for rejection with scintigraphy and sonography. Differentiation of ATN from rejection was more reliable with scintigraphy than with sonography.
对56例连续移植的同种异体肾进行了前瞻性的系列多普勒超声检查评估。在32例患者中发生了38次移植排斥反应（其中63%经病理证实），在24例患者中出现了24次急性肾小管坏死（ATN）。通过搏动指数（PI）、收缩压/舒张压比值（SDR）、舒张压/收缩压比值（DSR）和阻力指数（RI）对多普勒频谱波形进行特征分析。通过使用如下正常上限值来优化准确性：PI = 1.8，SDR = 4.0，DSR = 0.25，RI = 0.75。发生排斥反应的患者与发生ATN的患者在这些指标上没有显著差异。预测移植排斥反应的敏感性受到同一移植肾ATN病史或既往排斥反应史的不利影响。与同期放射性核素检查相比，闪烁扫描和超声检查对排斥反应的敏感性相似。与超声检查相比，闪烁扫描对ATN与排斥反应的鉴别更可靠。
